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Reducing unnecessary admissions related to 1-day stays: a collaborative effort.

Abstract

PURPOSE

To reduce the rate of inappropriate admissions to acute care inpatient prospective payment system hospitals

PRIMARY PRACTICE SETTING

Acute care hospitals.

METHODOLOGY AND SAMPLE

The study involved 3 measurement periods. A statistically valid sample of Medicare discharge claims with a 1-day length of stay (LOS for diagnosis-related groups 132, 141, 143, 182, and 183 was obtained from each participating hospital. Claims with discharge dispositions of 02 (transfers), 07 (left against medical advice), 20 (expired), and 66 (transferred to a critical access hospital) were excluded.

RESULTS

Seventeen acute care hospitals in Indiana collaborated with the quality improvement organization in reducing unnecessary admissions for the focused 1-day LOS admissions. The study resulted in a 2.6% relative improvement from baseline to remeasurement with an estimated overpayment of $1,494,294. In addition, there was a 42.6% decrease from baseline to remeasurement in the total number of claims meeting the study criteria.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

In many instances, case management can impact the following findings: Medical records sampled for this study, focusing on 1-day LOS, lacked documentation to support medical necessity for an inpatient admission. Diagnosis-related groups related to symptoms, such as DRG 143 (chest pain), are at high risk for not meeting admission necessity. The majority of patients admitted to an inpatient stay with complaints of chest pain-like symptoms were admitted through the emergency department. Lack of medical necessity for an acute inpatient admission is a potential risk for denial, impacting the revenue cycle and patient satisfaction. Outpatient observation should be utilized when evaluating an unconfirmed diagnosis.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Health Care Excel, Medicare Quality Improvement Organization, Terre Haute, IN 47803, USA. mi_helderman53@hotmail.com

    , , ,

    Source

    Professional case management 13:6 pg 318-28; quiz 329-30

    MeSH

    Case Management
    Cooperative Behavior
    Health Status Indicators
    Hospitalization
    Humans
    Length of Stay
    Patient Discharge
    Quality of Health Care
    Time Factors
    Utilization Review

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    19008757

    Citation

    Helderman, Mary, et al. "Reducing Unnecessary Admissions Related to 1-day Stays: a Collaborative Effort." Professional Case Management, vol. 13, no. 6, 2008, pp. 318-28; quiz 329-30.
    Helderman M, Kraemer YL, Dyer J, et al. Reducing unnecessary admissions related to 1-day stays: a collaborative effort. Prof Case Manag. 2008;13(6):318-28; quiz 329-30.
    Helderman, M., Kraemer, Y. L., Dyer, J., Davis, H. S., & Firestone, M. (2008). Reducing unnecessary admissions related to 1-day stays: a collaborative effort. Professional Case Management, 13(6), pp. 318-28; quiz 329-30. doi:10.1097/01.PCAMA.0000341640.35902.53.
    Helderman M, et al. Reducing Unnecessary Admissions Related to 1-day Stays: a Collaborative Effort. Prof Case Manag. 2008;13(6):318-28; quiz 329-30. PubMed PMID: 19008757.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Reducing unnecessary admissions related to 1-day stays: a collaborative effort. AU - Helderman,Mary, AU - Kraemer,Yvonne L, AU - Dyer,Jo, AU - Davis,Holly S, AU - Firestone,Milton, PY - 2008/11/15/pubmed PY - 2009/3/11/medline PY - 2008/11/15/entrez SP - 318-28; quiz 329-30 JF - Professional case management JO - Prof Case Manag VL - 13 IS - 6 N2 - PURPOSE: To reduce the rate of inappropriate admissions to acute care inpatient prospective payment system hospitals PRIMARY PRACTICE SETTING: Acute care hospitals. METHODOLOGY AND SAMPLE: The study involved 3 measurement periods. A statistically valid sample of Medicare discharge claims with a 1-day length of stay (LOS for diagnosis-related groups 132, 141, 143, 182, and 183 was obtained from each participating hospital. Claims with discharge dispositions of 02 (transfers), 07 (left against medical advice), 20 (expired), and 66 (transferred to a critical access hospital) were excluded. RESULTS: Seventeen acute care hospitals in Indiana collaborated with the quality improvement organization in reducing unnecessary admissions for the focused 1-day LOS admissions. The study resulted in a 2.6% relative improvement from baseline to remeasurement with an estimated overpayment of $1,494,294. In addition, there was a 42.6% decrease from baseline to remeasurement in the total number of claims meeting the study criteria. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: In many instances, case management can impact the following findings: Medical records sampled for this study, focusing on 1-day LOS, lacked documentation to support medical necessity for an inpatient admission. Diagnosis-related groups related to symptoms, such as DRG 143 (chest pain), are at high risk for not meeting admission necessity. The majority of patients admitted to an inpatient stay with complaints of chest pain-like symptoms were admitted through the emergency department. Lack of medical necessity for an acute inpatient admission is a potential risk for denial, impacting the revenue cycle and patient satisfaction. Outpatient observation should be utilized when evaluating an unconfirmed diagnosis. SN - 1932-8095 UR - https://www.unboundmedicine.com/medline/citation/19008757/abstract/Reducing_Unnecessary_Admissions_Related_to_1_day_Stays:_A_Collaborative_Effort_ L2 - http://Insights.ovid.com/pubmed?pmid=19008757 DB - PRIME DP - Unbound Medicine ER -